Sleep apnoea and insomnia: What’s the link? | ResMed UK

Do you struggle to sleep at night? Perhaps you wake in the early hours, tossing and turning until eventually nodding off just minutes before your alarm goes off? If so, you’re good company – of those questioned in our 2024 ResMed Sleep Survey, nearly 40% said they had fewer than three nights’ quality sleep a week, and it’s thought insomnia affects approximately 10% of the general population, while another 20% experience occasional insomnia symptoms1.

Many of us have a bad night’s rest from time to time. But when does a disrupted sleep pattern cross the line into insomnia, and how is it connected sleep apnoea? Neither condition is straightforward, so we spoke to Josh Piper, a sleep clinician at ResMed’s London Sleep Clinic, to guide us through the facts and help you get to the bottom of your sleep issues


Understanding insomnia ➜

What is sleep apnoea? ➜

Can insomnia be caused by sleep apnoea? ➜

Does treating sleep apnoea help with insomnia? ➜

Lifestyle changes for better sleep – for everyone! ➜

Diagnosing sleep disorders ➜

Understanding insomnia

While insomnia is defined as not being able to sleep – or stay asleep – at night, what that actually means can vary from person to person, as Josh explains: “Just because someone sleeps less than we would suggest, it doesn’t mean it’s a problem – unless they think it is!” This means that the onus is on the individual to report their sleep issues to a healthcare professional, which isn’t always easy! So what sort of issues should people be looking out for? Well, that depends on the type of insomnia you have.

Types of insomnia

  1. Acute insomnia: This is classed as a few weeks or nights of poor sleep. “These temporary sleep issues are often triggered by external forces, such as stressful situations, jetlag or major life events,” says Josh. Anyone who’s lain awake after a long-haul flight or when worrying about work may well sympathise!
  2. Chronic insomnia: In this case the sleep disturbances last for longer than three months, with sleep difficulties occurring at least three days per week2.

However, the categorisation doesn’t stop there – we can also break down insomnia according to the way people experience it:

  1. Onset insomnia: When someone takes a long time to go to sleep
  2. Maintenance insomnia: When someone wakes up during the night and struggles to get back to sleep – this may happen multiple times
  3. Complex insomnia: A combination of the two above categories


What causes insomnia?

“As we’ve seen, insomnia is a catch-all term for multiple types of sleep (or lack of sleep!) issues,” says Josh, “so it can be challenging to determine one root cause.”

However, if we look a bit more closely at the circumstances of an individual reporting sleep problems, we can assess if the insomnia is primary or secondary – which basically means whether it is linked to another health issue or not:

Primary: Not linked to a health issue – think back to the triggers for acute insomnia and things such as noise at night or too much light in the bedroom.

Secondary: Linked to a health issue or medical condition, pain, and/or the use of certain medications or drugs.


Who gets insomnia?

“Insomnia doesn’t discriminate, anyone can develop it,” says Josh. However, there are three Ps that can play a part in whether someone experiences insomnia: Predisposition and Precipitating and Perpetuating factors – as Josh explains:

Certain factors that may predispose someone to having insomnia include being female, being older, or having an underlying health condition such as diabetes, heart disease, kidney disease or high blood pressure.”

“But such predispositions are just one part of the story,” says Josh. “If someone has chronic insomnia there’s often a combination of precipitating factors (such as stressful life events) and perpetuating factors (ongoing behaviours that maintain a disrupted sleep rhythm – like excessive napping, or working shifts) contributing to it.”

So what about sleep apnoea – can that be a risk factor for insomnia too?

What is sleep apnoea?

In simple terms, sleep apnoea is a disorder that occurs when an individual stops breathing for periods of 10 seconds or more (known as ‘apnoeas’) during their sleep – this can happen anything from five to more than 30 times an hour. The most common type of sleep apnoea is obstructive sleep apnoea (OSA)3, where the apnoeas are caused by a narrowing (or obstructing) of the airway.

Obstructive sleep apnoea symptoms

Some of the most obvious symptoms of sleep apnoea take place at night, and as such it’s often the bed partner of the person with OSA who first notices something’s amiss – for example they may be disturbed by their partner snoring loudly4 or making gasping or choking sounds in their sleep. People with sleep apnoea may also experience night sweats5 and find they need to keep getting up at night to wee6.

Because having repeated apnoeas during the night disrupts sleep, people with OSA also tend to experience adverse effects during the day, including excessive daytime sleepiness, memory problems, headaches on waking, and low mood7.


Insomnia signs shared with sleep apnoea

Just like sleep apnoea, insomnia symptoms can be divided into those experienced during the day and night. The nighttime insomnia symptoms will come as no surprise as we’ve already mentioned them above: difficulty sleeping and early morning awakenings.

It’s also no surprise that if you’re experiencing sleep disruption due to insomnia you’ll probably feel tired during the day and have other symptoms associated with poor sleep, such as impaired memory and irritability… sound familiar?

As well as these symptoms, if either sleep apnoea or chronic insomnia goes untreated, it can impact your quality of life and even your health8. Research has shown that untreated obstructive sleep apnoea is associated with cardiovascular disease, stroke, diabetes, high blood pressure and even an increased risk of traffic accidents9.

Can insomnia be caused by sleep apnoea?

Now we’ve seen the similarities between the symptoms of these two conditions, you may be wondering whether insomnia is caused by sleep apnoea – or vice versa! Like many things in the complex world of sleep, the answer isn’t clearcut, especially as people can have both conditions at the same time, something doctors call ‘comorbidity’.

Comorbidity: having insomnia and sleep apnoea together

Josh explains: “There is a condition called COMISA, which stands for comorbid insomnia with sleep apnoea – and there’s thought to be a two-step circular relationship at play here.”10

  1. OSA leads to disrupted sleep with heightened nocturnal arousal (basically waking up more easily during the night), often leading to anxiety around sleeping – a precipitating
  2. The patient then sees their opportunities for sleep are reduced, and sleep remains fragmented – so they experience a ‘double whammy’ of less sleep, plus continued poor quality sleep.

The result? “It’s quite often that I see patients with untreated OSA who have an anxiety around sleeping because they know there’s a health risk and they don’t see any benefit from sleeping when they wake in the morning,” says Josh.

Does treating sleep apnoea help with insomnia?

With the above in mind, it seems logical that treating sleep apnoea could help with insomnia – and it’s true that the standard approach to COMISA is based around the idea that insomnia symptoms are secondary to OSA, so should improve once OSA is tackled11. Is that something Josh has seen in the sleep clinic? The short answer is yes: “Treating sleep apnoea can certainly help with insomnia,” says Josh, “as it provides consolidated periods of sleep where opportunity allows.” So how is sleep apnoea treated?

Treatment for OSA

There are several treatment options for sleep apnoea – including lifestyle changes or wearing a mandibular advancement device (an oral appliance a bit like a gumshield) at night. Sometimes surgery is recommended, although it’s not usually the first line of treatment as it’s an invasive procedure that doesn’t promise a positive outcome.

The ‘gold standard’ treatment for sleep apnoea is CPAP therapy12.

CPAP stand for continuous positive airway pressure, because that’s what a CPAP machine delivers. During CPAP therapy, the sleep apnoea patient wears a mask attached to the device. The device sends a steady stream of pressurised air to the mask – breathing in this air while they sleep helps keep the patient’s airways open, preventing apnoeas.

The benefits of CPAP therapy include more daytime energy13, a more positive mood14, clearer mind14 and – music to the ears of people who also have insomnia – better sleep.


Anxiety around sleep

However, Josh warns that if a patient has gone a long time without treatment for either their insomnia or sleep apnoea, they may have developed some of those perpetuating factors we talked about earlier – such as anxiety around sleep, which could hamper their progress.

“Often in the clinic patients who are new to treatment may feel that wearing a mask is only going to increase their anxiety around sleep,” says Josh. “However, with the right guidance from a qualified professional, they can see dramatic improvements to both elements of their sleeping issues.”

“This is why it can often be important for a patient to seek cognitive behavioural therapy for insomnia (CBT-i) as an adjunct to their CPAP therapy.”


Cognitive behavioural therapy for insomnia (CBT-i)

CBT-i aims to help change the way you think about sleep in general and has been shown to be effective for both chronic and comorbid insomnia15,16. During structured CBT-i sessions you’ll speak to a trained counsellor, who will help guide you towards a more positive mindset and address any underlying issues that may be stopping you getting enough sleep. They may also show you relaxation techniques. You will usually need to have around four to six sessions to see a difference, and will be set ‘homework’ to do between appointments to boost your progress.


Other treatments for insomnia

While CBT-i is normally the first course of treatment recommended for someone with insomnia, you doctor may also suggest other treatments, depending on your situation. For example they may ask you to try natural remedies or prescribe medications, known as hypnotics. It’s worth noting that most of these types of medicine are for short-term use (for example in cases of jetlag), and you would need to be weaned off any sleep aid medication before starting a course of CBT-i, as no practitioner should be doing CBT-i while a patient is using hypnotic medication.

Lifestyle changes for better sleep – for everyone!

As well as specific treatment for obstructive sleep apnoea and/or insomnia, there are lots of things that everyone can do to improve our sleep in general – regardless of whether you have a diagnosed sleep disorder or not. So even if you’re just reading this article on behalf of a loved one you can give them a go! These include:

  1. Being active during the day
  2. Avoiding screens at least an hour before bed
  3. Sticking to a sleep schedule (going to bed at the same time each night)
  4. Cutting caffeine and alcohol
  5. Watching your weight
  6. Creating a calm bedroom environment

In fact, we have a whole section of this website dedicated to healthy sleep habits, so take a look!

Diagnosing sleep disorders

Of course, sleep apnoea and insomnia aren’t the only things that can play havoc with your nightly rest. Other sleep disorders, such as restless legs syndrome or bruxism (grinding your teeth), could also be to blame. So if you’re feeling tired all the time and think poor sleep is the problem, a smart first step is to take our free online sleep assessment, as it could help you discover whether you’re being affected by OSA, insomnia, or another sleep issue.

This blog post contains general information about medical conditions and treatments. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. The information is not advice and should not be treated as such. You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider.

If you have any specific questions about any medical matter, you should consult your doctor or other professional healthcare provider. If you think you may be suffering from any medical condition, you should seek immediate medical attention. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website. The views expressed on this blog and website have no relation to those of any academic, hospital, practice, or other institution with which the authors are affiliated and do not directly reflect the views of ResMed or any of its subsidiaries or affiliates.


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